Nose: Septoplasty

Septoplasty

Indications

Correction of septal deviation which is causing nasal blockage (usually unilateral). Patient selection is crucial: many people have septal deviations, but this should only be corrected surgically if it is leading to constant (usually unilateral) nasal blockage once any inflammatory disease has been treated.

Bilateral/alternating/intermittent blockage is usually due to inflammatory disease, which is not affected by septoplasty, unless the deviation is clearly stopping steroid sprays from accessing the nasal cavity.

Occasionally required for access in endoscopic sinus surgery.

Procedure

An incision is made just inside the nostril. The lining of the septum (mucoperichondrium) is raised on one or both sides of the cartilage/bone. Deviated cartilage/bone is freed from its attachments, and either relocated, reshaped or removed so that the septum is straightened. The flaps are then re-approximated with sutures (dissolvable). Occasionally, silastic splints are used intranasally to maintain the shape of the septum and prevent adhesions.

Length of procedure

30-60 minutes.

Complications

Bleeding Warn the patient that they will have a congested nose with some discharge post-operatively. The discharge is often blood-stained initially but this will improve over time. Significant bleeding is uncommon. The patient should take it easy for a week to prevent excessive bleeding. Pain and blockage post-operatively may indicate a septal haematoma, which requires drainage.

Blockage Due to residual deviation, or the effects of underlying rhinitis.

Need for revision or further treatment As above.

Perforation A hole from one nasal cavity to the other. Usually due to tears in the mucoperichondrial flaps. Many perforations are asymptomatic, but they can cause crusting, blockage, bleeding or whistling depending on size and location.

Deformity Cartilage in the caudal and dorsal regions of the septum is preserved to prevent weakening the support of the nasal dorsum and tip. Failure to do so, or problems with healing, can lead to a dip in the nasal profile (saddle deformity), tip droop or columellar retraction. This is rare (<1%) but must be mentioned.

Anosmia Very rare, but possible due to fracture lines leading to the cribriform plate.

Post-operative management

Patients are usually discharged the same day. Packs are sometimes inserted at the end of the procedure to be removed later – check the operation note for instructions. Sutures do not need to be removed but occasionally splints are used which require removal – again, check the op note.

TTO

Usually some form of saline/alkaline nasal douching is given, along with simple analgesia. Nasal steroid spray/drops are sometimes given if there is concomitant rhinitis, to start a few days after the operation.